The Journal of Ambulatory Care Management This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Patient, Primary Care Provider, and Specialist Perspectives on Specialty Care Coordination in an Integrated Health Care System
This study used qualitative methods to compare these perspectives in an integrated health care system, using diabetes specialty care as an exemplar. Primary care providers and endocrinologists relied on interclinician relationships to coordinate care. Clinicians rarely included patients or other staff in their conceptualization of specialty care coordination. Patients often assumed responsibility for specialty care coordination but struggled to succeed. We identified several opportunities to improve coordination across the triad. In an integrated medical system, the shared organizational structure can facilitate these effo...
Source: The Journal of Ambulatory Care Management - January 1, 2018 Category: Emergency Medicine Tags: Original Articles Source Type: research

How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care: An Overview
This article provides suggestions for others hoping to develop similar tools/strategies for identifying patients' SDH needs in ambulatory care settings, with recommendations for further research. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - January 1, 2018 Category: Emergency Medicine Tags: Original Articles Source Type: research

From the Editor
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - January 1, 2018 Category: Emergency Medicine Tags: From the Editor Source Type: research

The Impact of Hospital Health Network Affiliation on Discharge Communication Preferences of Primary Care Providers
Primary care physicians (PCPs) experience differential postdischarge access to electronic health records, depending upon affiliation with the discharging hospital's health network. To better understand whether this affiliation impacts discharge communication preferences, we surveyed a convenience sample of PCPs in and out of our hospital's health network. We also surveyed hospitalists and compared PCPs' and hospitalists' responses. We found that PCP discharge communication preferences differed by hospital health network affiliation. In addition, PCPs and hospitalists reported different expectations of responsibility for pe...
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Rural Patients' and Primary Care Clinic Staffs' Perceptions of EHR Implementation: An Ethnographic Exploration
This focused ethnographic research study explores patients' and clinic staffs' experience of electronic health record (EHR) implementation in a small, independent, rural primary care practice. On the basis of participant observation of clinic staff, staff focus group, and patient interviews, results demonstrate that both patients and clinic staff have distrust and disconnect from technology. Yet, patients and clinic staff embrace patient-centered approaches and value team-based care. Understanding patients' and staffs' experience can facilitate the EHR implementation in the rural primary care setting and facilitate online ...
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Cost Estimates for Designing and Implementing a Novel Team Care Model for Chronically Ill Patients
Little is known about the cost of implementing chronic care models. We estimate the human resource cost of implementing a novel team-based chronic care model “Champion,” at a large multispecialty group practice. We used activity-based costing to calculate costs from development through rollout and stabilization in 1 clinic with 12 000 chronic care patients. Data analyzed included Microsoft Outlook meeting metadata, supporting documents, and 2014 employee wages. Implementation took more than 29 months, involved 168 employees, and cost the organization $2 304 787. Payers may need to consider a mixed-payment model to supp...
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Comparing Patient-Centered Medical Home Implementation in Urban and Rural VHA Clinics: Results From the Patient Aligned Care Team Initiative
Rural Veterans Health Administration (VHA) primary care clinics are smaller, have fewer staff, and serve more rural patients compared with urban VHA primary care clinics. This may lead to different challenges to implementation of the Patient-Centered Medical Home (PCMH) model, the Patient Aligned Care Team, in the VHAs' large integrated health system. In this cross-sectional observational study of 905 VHA primary clinics in the United States and Puerto Rico, we found overall PCMH implementation was greater in rural compared to urban primary care clinics. Urban-rural differences in PCMH implementation may largely be related...
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Primary Care and the Hypertension Care Continuum in Brazil
This study provides estimates of hypertension prevalence, awareness, treatment, and control in Brazil and assesses how well different modes of primary care delivery achieve each of these outcomes. Over one-third of the Brazilian adult population had measured hypertension or prior diagnosis. Nearly 90% of these had recent contact with the health system, but only 65% were aware of their condition. Only 62% of these regularly sought care for hypertension, but of these 92% received treatment. Hypertension control was 33% overall, but increased to 57% among those who received all levels of care. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Brazilian Payment for Performance (PMAQ) Seen From a Global Health and Public Policy Perspective: What Does It Mean for Research and Policy?
This supplement of the Journal of Ambulatory Care Management on the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ) reveals a relevant gap in the Brazilian literature on pay for performance/PMAQ, and is therefore an opportunity to bring contributions from global health and public policy to the debate. We discuss the relevant gap in the light of developments in evaluation and policy analysis. We afterward present the state of knowledge regarding global health and public policy in pay for performance, giving attention to diverse themes, methods, types of analyses, theoretical contributions,...
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Patient, Primary Care Provider, and Specialist Perspectives on Specialty Care Coordination in an Integrated Health Care System
This study used qualitative methods to compare these perspectives in an integrated health care system, using diabetes specialty care as an exemplar. Primary care providers and endocrinologists relied on interclinician relationships to coordinate care. Clinicians rarely included patients or other staff in their conceptualization of specialty care coordination. Patients often assumed responsibility for specialty care coordination but struggled to succeed. We identified several opportunities to improve coordination across the triad. In an integrated medical system, the shared organizational structure can facilitate these effo...
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care: An Overview
This article provides suggestions for others hoping to develop similar tools/strategies for identifying patients' SDH needs in ambulatory care settings, with recommendations for further research. (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

From the Editor
No abstract available (Source: The Journal of Ambulatory Care Management)
Source: The Journal of Ambulatory Care Management - November 29, 2017 Category: Emergency Medicine Tags: From the Editor Source Type: research

Reporting From the Front Lines: Implementing Oregon's Alternative Payment Methodology in Federally Qualified Health Centers
Alternative payment models have been proposed as a way to facilitate patient-centered medical home model implementation, yet little is known about how payment reform translates into changes in care delivery. We conducted site visits, observed operations, and conducted interviews within 3 Federally Qualified Health Center organizations that were part of Oregon's Alternative Payment Methodology demonstration project. Data were analyzed using an immersion-crystallization approach. We identified several care delivery changes during the early stages of implementation, as well as challenges associated with this new model of paym...
Source: The Journal of Ambulatory Care Management - August 30, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Measuring the Cost of the Patient-Centered Medical Home: A Cost-Accounting Approach
To explore the cost for individual practices to become more patient-centered, we inventoried and calculated the cost of costly activities involved in implementing the Patient-Centered Medical Home (PCMH) as defined by the National Committee for Quality Assurance. There were 3 key findings. The cost of each PCMH-related clinical activity can be classified in 1 of 3 major categories. Cost offsets can be used to defray part of the cost recognition. The cost of PCMH transformation varied by practice with no clear level or pattern of costs. Our study suggests that small- and medium-sized practices may experience difficulty with...
Source: The Journal of Ambulatory Care Management - August 30, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research

Short-term Impact of Meaningful Use Stage 1 Implementation: A Comparison of Health Outcomes in 2 Primary Care Clinics
We studied a primary care clinic transitioning to Meaningful Use stage 1 and a comparison clinic within the same health system. In the 6 months following implementation, after adjusting for confounders, mean systolic blood pressure worsened (+3.3 mm Hg; P = .004) in the intervention clinic compared with the comparison clinic. We did not see a change in the mean or proportion of patients meeting target goals for diabetes (hemoglobin A1c) or obesity (body mass index). Our findings suggest that the worsening of systolic blood pressure associated with Meaningful Use implementation is likely due to distractions of system change...
Source: The Journal of Ambulatory Care Management - August 30, 2017 Category: Emergency Medicine Tags: Original Articles Source Type: research